US healthcare industry needs to drop more non-essential workers, and invest more in workers that produce value. the industry is so bloated no wonder its costs are high. Just to get my ears checked i had to be processed by 6 different people including phone systems doing precheck-ins. one person does the actual work!
That "stupidly expensive" system provides extremely nice campaign donations, executives bonuses, stock appreciation, dividend checks, and paychecks to a stupidly large number of insiders. Even when they're (say) just medical billing clerks, who'll spend their entire careers arguing with the Denial Departments at various insurance companies, without every seeing an actual patient.
I want to agree with this, but these studies usually make a big mistake - they don't control out for the non healthcare reasons for low life expectancy.
Americans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact.
Has anyone dug into this to identify whether they tried to account for built environment? Or food system?
The system is bad but the average American is obese, out of shape, and pre-diabetic, an atrocious diets and very little exercise. That doesn’t explain everything, but it does strain the system, which has to treat a lot more disease than a similar system with a fit population.
It continues to baffle me that Americans put up with such an inferior and expensive system.
There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
The French riot in the streets if a single day of their extremely generous (by US standards) leave is taken away. Meanwhile Americand can’t get off the couch to protest, or are afraid of their own government if they do.
I find it remarkable that most comments either criticizing the US healthcare system or expressing bewilderment at how Americans seemingly accept this have already been downvoted into dead territory.
It's hard not to see those downvotes as copium or cognitive dissonance given no arguments have been presented to the contrary.
Zero mention of wait times in the US compared to other countries. Pretty sure that's the chief complaint in most countries that have free-ish healthcare.
You're exactly right but it runs contrary to the narrative being spun.
A quick search reveals the best ER wait times worldwide are in the US, Germany, and Switzerland, with most the rest of western Europe dead last along with Canada and Australia.
The average ER wait time in the US is 24 minutes. In France 2h21m. Italy 2h44m.
Everyone likes to say how great Canadian healthcare is, but talk to actual Canadians and the cracks start to show, you're waiting months for a CT scan, and most need employer-provided health insurance anyway to fill gaps in coverage.
> with most the rest of western Europe dead last along with Canada and Australia.
Just for completeness: I presume that is referring to government owned hospitals in Australia, which are free. There are also privately owned hospitals. I've not had to wait at a private hospital.
Private hospitals are expensive, but I suspect not as expensive as USA hospitals. The price is held in check by the alternative of "wait a little longer, and it's free".
I just moved from a medium sized US city and any specialist provider I contacted for myself or my parents was 5 months or more. It's not good everywhere.
This is my favorite thought terminating cliche when the discussion of American healthcare comes up. Wanna see a specialist? You're waiting. Can't afford insurance? You are waiting even longer.
I've experienced healthcare outside the US (in the UK) and it's on par with US healthcare in terms of wait times. Seeing a GP was same day with walk ins. When not busy, it was just a 5 minute wait.
Seeing a specialist can take time. I knew people that saw a 3 month wait to see a specialist in the UK. In the US, I just experienced a 3 year wait getting a specialist for my kid with autism. I had to go out of state to get the initial diagnosis, but to get local followup care I had to do that 3 year wait. After that, we were able to get a bunch of referrals to other issues.
What constrains wait time is how many doctors and specialists are working in a field. That has almost zero to do with the underlying payment system of a healthcare system.
Plenty of wait times in the US. Go to any clinic that accepts walk-ins in the afternoon, and you'll see a long line of sick, insured people waiting.
Getting a specialist in a major metro area will easily take 6-9 months. Family doctors? Anything to do with mental health? Good luck.
Oh, and if you think the situation is better in flyover country... It might be. You might have a world-class pediatric hospital in your zip code[1]. Or, more likely, you will have to drive 80 miles to a roach-motel-grade one. Turns out that poor people in real America don't have a lot of money, and it's not economical to provide them with any healthcare beyond leeching and bloodletting and four pills of Tylenol that will cost them $50.
Good luck getting an abortion, too.
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[1] You'll still get fraudulent bills sent to you by vendors who claim to have performed non-existent services on you, while the hospital won't even be able to tell you if those vendors even work for the hospital. Ask me how I know. (After days of digging, it turns out that no, they don't.)
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Look. It's entirely possible to in theory have a privatized system that works. Also, as Homer Simpson famously said, 'In theory, communism works.'
Unfortunately, we live in the real world, not a theoretical one.
1. At the very least, the data does not seem to be clear that the US has shorter wait times, and the US may even have longer wait times [1] (regardless of whether Americans pay far more and die younger).
2. Even in countries where people are unsatisfied with free-ish wait times (regardless of whether US waits might be longer), that average complainer may still not want a US-like system. I.e. people might complain about waits in their free-ish system but still think a (theoretically) faster US system is worse. I think a lot of people’s thought process is simply “I wish this were faster” which is still quite different from “I wish we had a fast US system.”
The US has half the number of medical school graduates compared to the average. Instead of creating a lunar base, maybe create more residencies to graduate doctors?
Quote:
“…has produced one of the lowest ratios of medical school graduates, 8.6 for every 100,000 people. This is far lower than the OECD average of nearly 15 graduates per 100,000 people.”
The entire healthcare system seems to be built against the population.
I've come to see healthcare providers like doctors, nurses, technicians, and the like, as a conniving, essential part of the scheme. They're incentivized to make you wait hours unnecessarily, rush every visit, and involve as many different people as possible in your care. And then, in the end, send ridiculous bills to both your insurance provider and to you at home. The person who spends the most time with you is usually the one trying to collect the payment. It's absurd.
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
There is absolutely no reason for a medical equipment provider to bill more than the retail price of a piece of equipment, especially after insurance has already paid more than the full cost of the equipment on each installment.
There is absolutely no reason for a family to receive a bill of almost one million dollars because their baby was premature and was in the NICU (see @thepasinins on instagram).
There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
The standard GP consult fee in Ontario Canada is $77.15. (just over us$50). That's gross, the nurse, receptionist and rent have to be paid out of that.
Some doctors will do 4 of those an hour, but most will do 6. And they'll try and find ways to bill additional codes above the consult.
There is a reason that doctors in the US make multiples of what doctors in Europe makes: the AMA lobbied the US CMS, back in the 1990s, to limit the number of residencies opened up every year, to avoid a "glut" of doctors. We have artificial scarcity of doctors.
> There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
Yeah, it basically all comes down to the bureaucratic nightmare that ultimately benefits the owners of all things medical. Prices have nothing to do with the value of the good or service and everything to do with the maximum amount of profit that can be extracted from a 3rd party.
One of the worst moves in the last 30 years was Clinton adding private insurance options onto Medicare. In the last 60 years was making medicaid a state run program rather than a national program (or just medicare all together). It's actually crazy that we have 53 different government healthcare options. 1 for every state, medicare, and the VA. It's even more crazy that the government doesn't simply directly employ doctors and medical equipment. It's so crazy inefficient to involve 3rd and 4th parties into something that should be direct care.
The US remains one of the only wealthy nations in the world without nationalized healthcare. And we pay through it through the nose.
> There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
The doctor isn't making $4000/hour, although you might be getting billed for that.
That doctor (unless some exotic specialist) is probably making not too far from ~300K, so that's around 144/hr, or $36 for that 15 minute conversation.
Blaming nurses and technicians feels a bit of an exaggeration. It's not as tho they're high in the hierarchy and have little say in pricing or other facets of why our healthcare system sucks. Maybe start the blame at politicians, insurers, pharmas and hospital owners and work your way down from there. Those with power and control should be the first to attack.
nurses are just following the protocol established by their organization; as are technicians; they have very little authority to deviate from prescribed protocols or they will be fired; it's unfair to ascribe any blame to them
physicians bear responsibility if its a private practice, but otherwise they're operating within the constraints of their org's protocols too, though they do have more autonomy (depending on the situation)
but really, your beef should be with the health organizations themselves
and also, many of these protocols are in place because _insurance companies_ require them to be in place
The main problem the US has is food. As a Spaniard myself, every time I go to the US it is really hard for me to eat well. Good quality food is extremely expensive and inconvenient (full of friction) compared to Japan or Europe.
The solution are not better Hospitals to deal with your diabetes or cancer after all your food has sugars it should not have like corn syrup because sugar is cheap. You have so much additives in your food for preservation. Meat is full of Hormones.
Antibiotics on your vegetables that destroy your microbiota. Genetically Modified to fill the fields with pesticides.
Now Americans are obese as they process the growth hormones from their meat and their microbiota dies from the antibiotics they eat in their vegetables and their meat.
Waiting until your children has autism or asthma or cancer is not the solution.
This doesn't ring true coming from the UK. I like in the US now and the healthcare is not comparable.
The UK health care system is an absolute joke, it's a running joke among a lot of the population. It's not free for a start, the taxes the population have to pay are eye watering. You have to wait weeks, if not months for a specialist, hospital beds are few, there is no accountability for regular fuck ups (I've been on the bad end of a horrific one).
The US system from what I have seen so far is a dream. It's cheaper and the service is top notch.
For context I've moved from the Midlands in the UK to the Research Triangle in North Carolina.
The US spends literally twice as much as the UK on healthcare per capita. So if by cheaper you mean literally 100% more expensive, then I guess you're on to something.
You know you're in trouble with all these kinds of analyses when they try to square up cost of care with life expectancy.
The principal components in life expectancy difference between the US and the other OECDs are car accidents, homicides, and CVD. Obviously, accidents and homicides aren't a function of the health care system; they're a function of the atypical dependence the US has on cars and its wildly atypical availability of firearms. Though: it is worth noting that the OECD definition of "preventable deaths" includes vehicular accidents!
But even the CVD statistics are misleading in a comparison like this. CVD outcomes are heavily regionalized in the US. The New England states have CVD outcomes comparable to western Europe. But go to Mississippi and Alabama and we look like a developing country. There's a lot of stuff going into that difference, but the key thing here is that the structural design of the health system is the same in both regions.
There's a lot not to like about the US system of employer-paid health insurance. But these kinds of critiques are frustrating and a little unserious, and it annoys me that this article assumes its readers won't dig into the crosstabs and will just take the comparison on faith. That's disrespectful to readers.
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
No doctor makes this much for a 15 minute conversation. A small portion of that money is going to the doctor. Much of it goes to all the other aspects of healthcare. The facility, other people involved in care, etc.
And no 15 minute visit costs 1000 dollars to the patient as well. That’s a pretty big exaggeration.
Ironic that another article posted to HN about the need for a socialist economy was flagged to oblivion. Clearly capitalism is doing a bang up job and discussion of alternatives is wholly inappropriate.
54 comments
[ 5.1 ms ] story [ 69.0 ms ] threadAmericans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact.
Has anyone dug into this to identify whether they tried to account for built environment? Or food system?
There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
The French riot in the streets if a single day of their extremely generous (by US standards) leave is taken away. Meanwhile Americand can’t get off the couch to protest, or are afraid of their own government if they do.
It's hard not to see those downvotes as copium or cognitive dissonance given no arguments have been presented to the contrary.
A quick search reveals the best ER wait times worldwide are in the US, Germany, and Switzerland, with most the rest of western Europe dead last along with Canada and Australia.
The average ER wait time in the US is 24 minutes. In France 2h21m. Italy 2h44m.
Everyone likes to say how great Canadian healthcare is, but talk to actual Canadians and the cracks start to show, you're waiting months for a CT scan, and most need employer-provided health insurance anyway to fill gaps in coverage.
Just for completeness: I presume that is referring to government owned hospitals in Australia, which are free. There are also privately owned hospitals. I've not had to wait at a private hospital.
Private hospitals are expensive, but I suspect not as expensive as USA hospitals. The price is held in check by the alternative of "wait a little longer, and it's free".
It's just a blatant lie.
I've experienced healthcare outside the US (in the UK) and it's on par with US healthcare in terms of wait times. Seeing a GP was same day with walk ins. When not busy, it was just a 5 minute wait.
Seeing a specialist can take time. I knew people that saw a 3 month wait to see a specialist in the UK. In the US, I just experienced a 3 year wait getting a specialist for my kid with autism. I had to go out of state to get the initial diagnosis, but to get local followup care I had to do that 3 year wait. After that, we were able to get a bunch of referrals to other issues.
What constrains wait time is how many doctors and specialists are working in a field. That has almost zero to do with the underlying payment system of a healthcare system.
Getting a specialist in a major metro area will easily take 6-9 months. Family doctors? Anything to do with mental health? Good luck.
Oh, and if you think the situation is better in flyover country... It might be. You might have a world-class pediatric hospital in your zip code[1]. Or, more likely, you will have to drive 80 miles to a roach-motel-grade one. Turns out that poor people in real America don't have a lot of money, and it's not economical to provide them with any healthcare beyond leeching and bloodletting and four pills of Tylenol that will cost them $50.
Good luck getting an abortion, too.
---
[1] You'll still get fraudulent bills sent to you by vendors who claim to have performed non-existent services on you, while the hospital won't even be able to tell you if those vendors even work for the hospital. Ask me how I know. (After days of digging, it turns out that no, they don't.)
---
Look. It's entirely possible to in theory have a privatized system that works. Also, as Homer Simpson famously said, 'In theory, communism works.'
Unfortunately, we live in the real world, not a theoretical one.
2. Even in countries where people are unsatisfied with free-ish wait times (regardless of whether US waits might be longer), that average complainer may still not want a US-like system. I.e. people might complain about waits in their free-ish system but still think a (theoretically) faster US system is worse. I think a lot of people’s thought process is simply “I wish this were faster” which is still quite different from “I wish we had a fast US system.”
[1] https://www.americanprogress.org/article/truth-wait-times-un...
But, as with most things, the US is too big for any one persons experience to be universally applicable.
As I said, it’s what most people express that I talk to. But that doesn’t mean I think it’s true for every area of the country.
Quote:
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
There is absolutely no reason for a medical equipment provider to bill more than the retail price of a piece of equipment, especially after insurance has already paid more than the full cost of the equipment on each installment.
There is absolutely no reason for a family to receive a bill of almost one million dollars because their baby was premature and was in the NICU (see @thepasinins on instagram).
There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
Some doctors will do 4 of those an hour, but most will do 6. And they'll try and find ways to bill additional codes above the consult.
Yeah, it basically all comes down to the bureaucratic nightmare that ultimately benefits the owners of all things medical. Prices have nothing to do with the value of the good or service and everything to do with the maximum amount of profit that can be extracted from a 3rd party.
One of the worst moves in the last 30 years was Clinton adding private insurance options onto Medicare. In the last 60 years was making medicaid a state run program rather than a national program (or just medicare all together). It's actually crazy that we have 53 different government healthcare options. 1 for every state, medicare, and the VA. It's even more crazy that the government doesn't simply directly employ doctors and medical equipment. It's so crazy inefficient to involve 3rd and 4th parties into something that should be direct care.
The US remains one of the only wealthy nations in the world without nationalized healthcare. And we pay through it through the nose.
The doctor isn't making $4000/hour, although you might be getting billed for that.
That doctor (unless some exotic specialist) is probably making not too far from ~300K, so that's around 144/hr, or $36 for that 15 minute conversation.
All the rest is being siphoned off by the system.
How exactly?
physicians bear responsibility if its a private practice, but otherwise they're operating within the constraints of their org's protocols too, though they do have more autonomy (depending on the situation)
but really, your beef should be with the health organizations themselves
and also, many of these protocols are in place because _insurance companies_ require them to be in place
The solution are not better Hospitals to deal with your diabetes or cancer after all your food has sugars it should not have like corn syrup because sugar is cheap. You have so much additives in your food for preservation. Meat is full of Hormones.
Antibiotics on your vegetables that destroy your microbiota. Genetically Modified to fill the fields with pesticides.
Now Americans are obese as they process the growth hormones from their meat and their microbiota dies from the antibiotics they eat in their vegetables and their meat.
Waiting until your children has autism or asthma or cancer is not the solution.
When basic exams cost them easily US$100k, you know the system is broken.
Health system is a business model in the US, and people who are organ donor are literally being murdered to have their organs removed.
Don't trust my owners, you won't need much to find that out.
The UK health care system is an absolute joke, it's a running joke among a lot of the population. It's not free for a start, the taxes the population have to pay are eye watering. You have to wait weeks, if not months for a specialist, hospital beds are few, there is no accountability for regular fuck ups (I've been on the bad end of a horrific one).
The US system from what I have seen so far is a dream. It's cheaper and the service is top notch.
For context I've moved from the Midlands in the UK to the Research Triangle in North Carolina.
The principal components in life expectancy difference between the US and the other OECDs are car accidents, homicides, and CVD. Obviously, accidents and homicides aren't a function of the health care system; they're a function of the atypical dependence the US has on cars and its wildly atypical availability of firearms. Though: it is worth noting that the OECD definition of "preventable deaths" includes vehicular accidents!
But even the CVD statistics are misleading in a comparison like this. CVD outcomes are heavily regionalized in the US. The New England states have CVD outcomes comparable to western Europe. But go to Mississippi and Alabama and we look like a developing country. There's a lot of stuff going into that difference, but the key thing here is that the structural design of the health system is the same in both regions.
There's a lot not to like about the US system of employer-paid health insurance. But these kinds of critiques are frustrating and a little unserious, and it annoys me that this article assumes its readers won't dig into the crosstabs and will just take the comparison on faith. That's disrespectful to readers.
No doctor makes this much for a 15 minute conversation. A small portion of that money is going to the doctor. Much of it goes to all the other aspects of healthcare. The facility, other people involved in care, etc.
And no 15 minute visit costs 1000 dollars to the patient as well. That’s a pretty big exaggeration.